CISCO FLOORING SUPPLIES- CASH/COD Account

Company Profile - CASH/COD Account
Date*

MonthDayYear
COMPLETE BUSINESS NAME*
DBA IF APPLICABLE
NAME
DBA IF APPLICABLE

First NameLast Name
STREET*
CITY*
STATE*
ZIP*
PHONE*
EMAIL*
example@example.com
Ship To Address (if different than business address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
TYPE OF BUSINESS*

IndividualPartnershipCorporation
Do you have one of the following?

ShowroomWarehouseN/AOther
Customer Type

General ContractorKitchen & BathInstallerPool ContractorRemodelerOther
PREFERRED CISCO LOCATION*
Are you working with a Sale Representative?

NoYes
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Are you tax exempt? If yes, you are required to upload the document.*
Upload Tax Exempt Document *

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Upload Driver License Photo

Checks are only accepted when a driver's license is uploaded. If you do not upload your driver's license, only cash and credit cards will be accepted.
Cancelof
Payments are due at time of purchase. All returned checks, including but not limited to NSF, Stopped Payment or Closed Account checks, are subject to a 5% or $25 fee, whichever is greater. In the event CISCO Flooring Supplies takes any action, with or without suit, to enforce these terms of sale, Customer shall be responsible for CISCO Flooring Supplies costs including its reasonable attorney's fees incurred through trial and any appeals. Exclusive jurisdiction for any legal action shall be in a court of competent jurisdiction.

THE UNDERSIGNED AGREES TO BE BOUND BY THE TERMS AND CONDITIONS OF SALE LISTED ABOVE.
SIGNATURE*

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PRINT NAME*
Title*
Company*
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Company Profile - CASH/COD Account